Socioeconomic and Racial/Ethnic Disparities in Cancer Mortality, Incidence, and Survival in the United States, 1950-2014: Over Six Decades of Changing Patterns and Widening Inequalities

Abstract

We analyzed socioeconomic and racial/ethnic disparities in US mortality, incidence, and survival rates from all-cancers combined and major cancers from 1950 to 2014. Census-based deprivation indices were linked to national mortality and cancer data for area-based socioeconomic patterns in mortality, incidence, and survival. The National Longitudinal Mortality Study was used to analyze individual-level socioeconomic and racial/ethnic patterns in mortality. Rates, risk-ratios, least squares, log-linear, and Cox regression were used to examine trends and differentials. Socioeconomic patterns in all-cancer, lung, and colorectal cancer mortality changed dramatically over time. Individuals in more deprived areas or lower education and income groups had higher mortality and incidence rates than their more affluent counterparts, with excess risk being particularly marked for lung, colorectal, cervical, stomach, and liver cancer. Education and income inequalities in mortality from all-cancers, lung, prostate, and cervical cancer increased during 1979-2011. Socioeconomic inequalities in cancer mortality widened as mortality in lower socioeconomic groups/areas declined more slowly. Mortality was higher among Blacks and lower among Asian/Pacific Islanders and Hispanics than Whites. Cancer patient survival was significantly lower in more deprived neighborhoods and among most ethnic-minority groups. Cancer mortality and incidence disparities may reflect inequalities in smoking, obesity, physical inactivity, diet, alcohol use, screening, and treatment.

Figure 1

Weighted correlations between area socioeconomic index and county-level age-adjusted cancer mortality rates, United States, 1950–2014.

Figure 2

Trends in all-cancer mortality by area socioeconomic deprivation index, United States, 1950–2014.

Figure 3

Trends in all-cancer mortality and incidence rates by race, United States, 1950–2014. The 9 SEER registries include San Francisco-Oakland, Connecticut, Detroit-Metropolitan, Hawaii, Iowa, New Mexico, Seattle-Puget Sound, Utah, and Atlanta-Metropolitan.

Figure 4

Trends in lung, colorectal, breast, and cervical cancer mortality rates by area socioeconomic deprivation index, United States, 1950–2013.

Figure 5

Cancer survival by census tract socioeconomic index and race/ethnicity, all sites and both sexes combined, 1988–94 patient cohort. Note: based on data from 11 SEER registries that include the states of Connecticut, Hawaii, Iowa, New Mexico, and Utah; and the metropolitan areas of Atlanta, Detroit, Los Angeles, San Francisco and Oakland, San Jose and Monterey, and Seattle.

Figure 6

Cancer survival by census tract socioeconomic deprivation index, 11 SEER registries, United States, 1988–1999.